[The following is provided ONLY as information to be discussed with your prescribing physician. All patients are different and this data may be counter to the way your doctor feels you, or your childs case, must be handled.] Provided by Dr. Koch to specific patients __________________________________________________________________________ William H. Koch, M.D., P.C. Child and Adult Psychiatry 20 West 64th Street New York, NY 10023 212.799-8204 Dear Parents: The use of psychoactive medication in children is an important and serious step. Instructions should be followed carefully. No change in dosage or in the time(s) medication is given should be made without first consulting with me. If you have any concerns about a possible side effect, or if you feel your child is overmedicated or undermedicated, I should be contacted immediately. Ritalin should always be given on an empty stomach. When your stomach is empty, there is a minimum of acid present. The medicine passes through very quickly and is not effected by stomach acid. When you eat, there is an outpouring of acid, the medicine stays in the stomach much longer and is inactivated by the acid. Ritalin is to be taken 3 to 5 minutes before a meal. If you wait longer than five minutes after the medication is taken to start the meal, the child may lose his or her appetite. Ritalin should be taken with water. Do not use fruit juices, soft drinks, or milk. Most juices and soft drinks are acidic and will also inactivate the medication. Milk causes the medicine to stay in the stomach longer. Learning, reading and focusing are not limited to being in school. Unless otherwise directed, medicine should be given seven days per week, 365 days per year. If you miss a dose, however, there is no cause for alarm. The medicine is effective for only four hours and is not cumulative. Depending on the child, children will be re-evaluated every one to six months. Prescriptions will not be written for any child who has not been seen within six months. Contact my office at least a week in advance when a new prescription is needed. Do not wait for the "last two pills" to call. Prescriptions must be written and mailed to you as they are not renewable by telephone to a pharmacist. Fill the prescription immediately, as the form is only good for 30 days. If you have any questions about the medication at any time, the safest and most reasonable thing to do is to call me. William H. Koch, M.D. (c)1993 William H. Koch __________________________________________________________________________ Remember, the info contained above is only a guide for discussion and MUST NOT be followed without detailed discussion with your M.D. __________________________________________________________________________ This article has been downloaded from the ADD Forum on CompuServe, and may be distributed freely as long as the contents of the file are unchanged. Because the CompuServe ADD Forum is new, we are frequently asked how to join CompuServe and get on the forum. Call 1-800-524-3388 and ask for rep #464. Outside the US/Canada call +1-614-457-0802.